Nerve block procedures can play a critical role in greatly improving a person’s quality of life after years spent struggling with severe pain. But they are not infallible, and often represent just one major step in a series of steps to achieving a better life.
Nerve blocks have been in use for decades, and their origins trace back to early anesthesiology – while modern medicine has allowed us to target specific nerves and joints in order to induce a state of painlessness, the practice of blocking a nerve or muscle is ancient, anecdotally tracing as far back as the 2nd century. Yet while a more targeted approach has allowed us to tackle more complex and invasive forms of pain, it’s still not a perfect procedure. In other words, the effectiveness of the procedure may vary.
Your Pain Mileage May Vary
Pain is complex and entirely subjective, existing only as a personal experience. The degree to which a nerve block helps with any given form of chronic pain depends on the patient’s perception.
While nerve blocks aim to generally provide relief by acting on major nerves, chronic pain can often have several origin points, making it difficult to say for certain that any given nerve block will address all areas affected by a specific condition or form of pain.
That isn’t to say that nerve blocks are unreliable forms of treatment. But it is meant to serve as a reminder that they’re just one way in which medicine can help address pain. In most cases, nerve blocks serve only to improve mobility and quality of life, in so far that they help patients pursue more aggressive means of physical therapy to achieve long-term pain relief.
The rate at which a nerve block blocks the pain is also subjective. Some people feel immediate pain following the injection. Others only begin to feel better a few hours after the injection. Some people achieve powerful pain relief, while others only feel a little better. In cases of intractable or terminal pain, frequently applied nerve blocks may be one among a series of procedures that help address the pain.
The Right Treatment Frequency
Nerve blocks are typically reapplied anywhere from thrice a year to six times a year, depending on their effectiveness and the progress a patient has made between their injections. Because nerve blocks aim to provide temporary pain relief to aid in the application of other treatments and pain management techniques, the frequency at which a nerve block is applied depends on how the patient responds to the nerve block, how long the relief lasts, and how much of their pain has returned once the nerve block fully wears off.
Ideally, once the pain becomes manageable through non-invasive means, nerve blocks are no longer necessary. Although they are quick procedures, they do present some measure of risk, from the risk of bleeding or infection to the risk of causing permanent damage, rather than temporary numbing. The odds for these risks are small, as they are often caused by human error, and the professionals who administer nerve blocks are highly trained and often very experienced.
Needles Aren’t That Bad
About 10 percent of American adults are afraid of needles – to the point that some avoid them even when they’re necessary, and some argue that the actual number is much higher, and completely undocumented. A ‘fear’ of needles is diagnosed when the thought or experience of being punctured with a needle evokes a vasovagal reflex, or a physical reaction triggered by fear, involving a sudden spike in heart rate, followed by a sudden drop (with potential unconsciousness).
This is one of the more common fears, and one that makes sense. Penetrating the skin is a very unpleasant experience, and while countless cultures feature traditional piercings, skin art, and even forms of ritual mutilation, we also have a natural inclination not to be stabbed or pricked.
Yet it can present itself as a major hurdle when contemplating the use of a nerve block for treatment, as it’s typically a needle-intensive procedure. While a nerve block can be administered in as few as five minutes, it may involve as many as six injections.
The basic step-by-step of any given nerve block involves introducing a special imaging liquid into the body through a very long needle and using fluoroscopy to create a clear guide for the treatment to be administered through a different needle. Sometimes, sedation may be administered through an IV.
Yet despite the frequency with which needles are used throughout this process, more time is spent preparing for the procedure, and then resting afterwards. It’s standard for a patient to remain at the clinic shortly after the nerve block is completed to observe them for any potential complications or side effects.
Expect to Be Sore
It’s normal to feel uncomfortable around the injection site for up to a day, or longer. This soreness wears off after a while and is a natural response by the body. It’s typically advised that you arrange for someone to pick you up and bring you home after the procedure is complete, and most people are advised not to engage in any strenuous physical activity for at least a day after the procedure.
After Your Nerve Block Procedure
Follow up is critical. Stay in touch with your doctor and tell them how you feel. Knowing how the steroid affects your condition over the course of the next two weeks is important to determining where the pain may be coming from, and what kind of treatment would work best in the long-term.
A nerve block does not have to be a last resort – sometimes, it can be a useful diagnostic tool when no other means present themselves. And sometimes, frequent nerve blocks present the best chance someone has of maintaining a good quality of life in the face of overwhelming and constant pain. Regardless of when or why a nerve block is recommended, it’s still a procedure that one must be properly prepared for.
Common Questions About Nerve Blocks
A nerve block is the injection of numbing medication (local anesthetic) near specific nerves to decrease your pain in a certain part of your body during and after surgery. For specific types of surgery, your anesthesiologist may place a “nerve catheter,” which may be used to continuously bathe the nerves in numbing medication for 2-3 days after the surgery and sometimes longer when necessary. A nerve block is not for everyone and your anesthesiologist will evaluate whether it is the right option for you.
A nerve block decreases your pain during and after surgery. It is more effective than pain medications through the IV. Because you have less pain, you will need less oral or IV pain medications, even though you will have the medications available to you. You will have fewer side effects of pain medications, such as respiratory depression, itching, nausea, and somnolence. In addition, you may be able to avoid a general anesthesia. Sometimes, a nerve block is done in addition to a general anesthesia for pain relief after the surgery.
Like general anesthesia, nerve blocks involve some side effects and risks. Most common side effects include unpleasant numbness and weakness of the muscle, when catheters are placed a little bit of leak can occur around the catheter entry and that is totally normal. It is also normal to experience some pain after surgery despite the block. As the block wears off, pain usually increases and it is important to take oral medications early to help control it. Serious complications are very rare (<0.1%) and include large bruise or infection at the block area and persistent nerve symptoms and those are usually temporary.
The placement of a nerve block is associate with minor discomfort. Most patients report that it is less painful than the placement of a small IV catheter. Many patients are given sedating medicine to help them relax and then numb the skin prior of the nerve block placement.
The nerve block is done predominantly under ultrasound guidance, which is the most modern technique. This technique allows us to see the needle direction and local anesthetic injection in “real time.”